5 4 II Wound Healing

8/12/2019 5 4 II Wound Healing

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Diabetic neuropathy

Wound healing

Section 5 | Part 4-II of 4

Curriculum Module III–7c | Diabetic neuropathy



Diabetic neuropathyWound healing

Curriculum Module III-7Slide 2 of 3


The diabetic foot

• Neuropathy – principal problem

• Vascular disease – secondary






Four types of ulcers

• Neuropathic ulcers

• Ischaemic ulcers

• Neuroischaemic ulcers

• Venous ulcers






Determine aetiology

• Neuropathic?

• Vascular?

• Mixed? predominant pathology?

• Determine wound management

• Act quickly






Neuropathic ulcers

• Area of pressure

• Callus

• Red granulating base• Low-to-moderately

exudative

•Bounding pulses

• Painless






Intrinsic – biomechanical






Extrinsic – thermal






Extrinsic – footwear






Extrinsic – chemical






Management of neuropathic ulcers

• Treat infection

• Debridement of callus

• Reduce pressure

• Restrict walking

• Dressings

b h






Pre- and post-debridement

Di b ti th






Felt deflection

• Reduces pressure by 61%

• Simple and cheap

• Replace weekly

• Impractical for exudatingulcers

• Risk of tinea/skin tears

Di b ti th






Ulcer healing with felt deflectivepadding

Week 1: pre-debridement Week 1: post-debridement

Week 3 Week 6: healed

Diabetic neuropathy






Pre-fabricated casts

• Simple to use

• Will not fit all feet

• Removable

• Less effective inmaintaining footshape

Diabetic neuropathy






Ischaemic ulcer

• On toes and foot margins

• Pale granulation, sloughytissue or eschar

• Dry with irregularborders

• Painful

• Pulses weak orimpalpable

Diabetic neuropathy






Management of ischaemic ulcers

• Vascular assessment andtreatment

• Treat infection

• Pain management

• Dressings

• Avoid compression/bandaging

Diabetic neuropathy






Treatment goals

• Control infection

• Improve blood supply

• Optimize wound healingenvironment

• Protect wound from trauma



Diabetic neuropathy






Practice tips: neuropathic ulcers

• Foams 2 cm larger than thewound

• Use gels sparingly

• Keep foot dry – wash separately

• Do not use occlusive dressings

• Extra pads increase pressure andocclude the wound





Diabetic neuropathy






In diabetes, clinical signs may

be masked leading to delayed

diagnosis of infection.

Diabetic neuropathy



p yWound healing



Do not withhold antibiotics until results

of culture available

Rely on clinical judgement

Diabetic neuropathy



p yWound healing



Antibiotic treatment is an essential

aspect of treating diabetic foot ulcers

– maintain until ulcer has healed.

Depending on clinical response,

frequent changes and long-term

antibiotics may be required.

Diabetic neuropathy



Wound healingCurriculum Module III-7

Slide 25 of 3


Foot infection

• Ulcer = risk of infection

•Osteomyelitis (sausage toe)

• Amputation

Diabetic neuropathy




Slide 26 of 3


Treatment of osteomyelitis

• Antibiotics

– minimum of 3 months until

there is evidence of healingon x-ray or scan

• Infected bones may need to be

removed surgically

Diabetic neuropathy




Slide 27 of 3


Prevention of the diabetic footdisease

Primary prevention

• No successfulclinical trials

• Metabolic control

• Smokingcessation

Secondary prevention

• Identify high riskfeet

• Foot education

• Foot care

•Management ofactive foot problems(ulceration)

Diabetic neuropathy




Slide 28 of 3


Key points

• Assess

• Determine aetiology

• Arrange appropriate woundmanagement



Diabetic neuropathyW d h liACTIVITY




Slide 30 of 3

ACTIVITY


Case study

• Pulses absent

• ABI’s

Left - 0.69

Right - 0.71

• Left 1st MPJ ulcer

• Right hallux (great toe)ulcer – had bypass nowABI improved to 1.00



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5 4 II Wound Healing